What is a Stress Response/Reaction? And what are the Physiotherapy Benefits?

A bone stress response, also known as a bone stress reaction, refers to a condition where bone tissue undergoes a localized adaptive response to repetitive mechanical loading. It falls along a spectrum of bone injuries, with stress reactions being less severe than stress fractures. These conditions are often associated with overuse or increased physical activity without adequate rest and recovery, leading to cumulative microtrauma to the bone. 

Bone stress responses/reactions are commonly found in weight-bearing bones that are subjected to repetitive impact and loading. Some common locations include: 

• Tibia (shinbone) 

• Metatarsals (foot bones) 

• Femur (thighbone) 

• Calcaneus (heel bone) 

• Fibula (the smaller bone in the lower leg) 

• Pelvis 

• Lower back (lumbar spine) 

Signs and symptoms of a bone stress response/reaction can vary, but they often include: 

• Gradual onset of localized pain, often described as a dull ache. 

• Pain that is exacerbated by activity or weight-bearing and may lessen with rest. 

• Pain that is more pronounced during the initial stages of activity and may improve as the activity continues. 

• Tenderness or discomfort when pressing on the affected area. 

• Swelling or mild inflammation around the affected bone. 

• In more severe cases, pain may become constant and more intense. 

Physiotherapy can play a supportive role in the management of bone stress responses/reactions, particularly during the rehabilitation phase. Here's how physiotherapy can help: 

• Load management: Physiotherapists can guide individuals in modifying their activity levels and providing a structured return-to-activity plan to gradually reintroduce stress to the bone while allowing proper healing. 

• Biomechanical assessment: A thorough assessment of movement patterns, muscle imbalances, and biomechanics can help identify contributing factors to the stress response. Physiotherapists can provide exercises and interventions to address these issues and reduce the risk of recurrence. 

• Muscle strengthening and conditioning: Specific exercises targeting the muscles around the affected bone can help distribute forces more evenly and reduce strain on the bone. This can aid in recovery and prevent further stress. 

• Gait analysis: Analysing walking and running patterns can help identify any abnormalities that might contribute to the condition. Physiotherapists can provide guidance on correcting gait mechanics to alleviate stress on the affected bone. 

• Manual therapy: Hands-on techniques like soft tissue mobilization and joint mobilization can help improve tissue mobility, reduce muscle tension, and promote healing. 

• Education: Physiotherapists can educate patients about proper warm-up routines, cool-down exercises, and self-care strategies to optimize bone health and prevent future occurrences. 

• Collaboration: Physiotherapists often work as part of a multidisciplinary team, collaborating with orthopaedic doctors, radiologists, and other healthcare professionals to ensure comprehensive care.